Nordic Journal of Nursing Research

The premature child is very sensitive to even small stimulus from the environment. Pain can cause a stress reaction leading to severe complications. Therefore the care for a premature child seeks to prevent any unnecessary negative stimulus. In order to support vital functions PO2 and PCO2 are monitored continuously. The monitoring device has to be changed eight times a day, and in the staff experience this procedure causes the child pain. The aim of the study was to describe whether premature children experience pain when the device to monitor PO₂ and PCO₂ is changed. Over a period of three months all children born before week 32 admitted to the neonatal care unit at a Danish county hospital were allocated to the study. All together 9 children participated. At least one episode of changing the monitoring device was recorded on video for each child. The eighteen video recordings were analysed by three nurses using the Premature Infant Pain Profile (PIPP) scoring system to assess the pain intensity experienced by the child. PIPP score above 12 indicate severe pain. All children experienced severe pain during the change procedure as they got a PIPP score between 13 and 18 with a median score of 15. This pilot study has demonstrated that premature children experience severe pain by the nursing procedure. It is therefore suggested that a method is developed insuring the necessary assessment of vital functions without causing unnecessary risk to the children.

The purpose of this study was to gain knowledge of patients' experience of the milieu at a Psychiatric Centre. As most psychiatric patients to day are living in their own homes, the psychiatric services must adjust and offer day- and night-care as well as outpatient services to cope with crises and training needs. Eleven patients using such a centre were interviewed about their experience. Qualitative data were analysed and themes exposed. The informants described the centre as a sanctuary where all the patients were allowed to participate in their own health process, and were given the time and space they needed. They felt welcome and respected. The crucial aspect was that they were allowed to participate without interference from the staff, but were taken good care of when they felt poorly. The patients decided the topics of conversations, however some topics where avoided. The staff always took care immediately if they were in trouble, otherwise they had to wait until it was their turn.

The result show several paradoxes, like how to be taken care of without feeling belittled, how to let the patient participate in the decision-making process in the group and the activities at the centre.

Assessing pain in children is one of nurses' most difficult tasks and provides the foundation for efficient pain management. Young children lack the verbal skills to describe their experience of pain and they also have problems in differentiating pain from other unpleasant experiences. The aim of this study was to review current research regarding pain assessment in children. A literature search was carried out in the CINAHL and Medline databases, using the search words «pain assessment», «pain measurement», «pain rating scales», «children» and «nursing» and was limited to the years 1997–2002. Twelve articles satisfied the inclusion criteria and were analysed. The results are highlighted in five areas: Assessment of pain in children; Assessment of pain in infants; Tools and scales for assessing pain; Factors influencing the nurse's assessment of pain; pain assessment as a basis of efficient pain therapy. The results of the study point to problems in pain assessment and the importance of children's pain being adequately assessed. Accordingly, it is of utmost importance when possible to be able to take into account the individual child's experience of pain.

In health care, we frequently encounter individuals who are in life demanding situations. Their experience can challenge a person's ontological view of life, his understanding of life. Understanding of life means, from an ethical point of view, that the caregiver and the patient meet each other in their respective understanding of life. To actually witness the patient's suffering implies an ethical demand of care for the patient that becomes a testimony to the possibility of focusing light onto the darkness of understanding of life. The aim of this study is to perform a dialogue between the ethics of understanding of life, witnessing, and concrete acts of ethical caring. The ethics of understanding of life is made explicit in the ultimate goals of caring acts; to enhance understanding of life. The ethics of understanding of life cannot be used directly but as an ontological ground for acts of caring, as ethics proceeds ontology. This could be made explicit through witnessing from different aspects. The ultimate goal is mirrored by concrete acts of ethical caring. Experiences of relief of suffering and changing understanding of life give evidence to the ethics of understanding of life from the patient's perspective.

This article is part of an ethnographic study that aims to describe and understand health as a phenomenon of the Sami culture. It discusses the preparation for and practices of fieldwork in the Sami region of Finnish Lapland. The article focuses on the relationships between the researcher and the experts, the researcher's personal qualities and adaptation to the field as well as the development of cultural understanding and the collection of data. The basic ideas in the preparation and fieldwork practices were related to ethical questions on the one hand. On the other hand, the purpose of this process was to guarantee the credibility of the study. The preparation for fieldwork included gathering background information about the context and the cultural group and analysing the majority-minority aspects concerning Finns and Sami. In addition, it included an assessment of the researcher's personal qualities and experiential background. The cultural understanding of health was constructed gradually in repeated meetings of the researcher with the participants, and data collection was situationally flexible. The process of analysis described in this article was a long-term cultural learning process that included multi-staged reflection.

Clinical research, when children involved, may cause difficult ethical problems for both caregivers and parents. Informed consent has to be obtained from the parents and from the child depending on age and maturity. The concept of informed consent is complicated and depending on the ability of communication between the professionals and the parents. The aim of the study was to illuminate parents lived experiences when being asked to volunteer their new-born premature child to a clinical research study. Parents of fifteen children were interviewed concerning their experiences and a phenomenological based analysis was carried out. Three themes were found: experience of exposure, experience of insufficiency and experience of possibilities. The parents expired themselves being in a state of shock and their statements were characterised by the existing chaos. Despite this, the parents experienced that they could do something good for others in the future. Researchers have to be aware of the parents' exposure, and attentive to their individual needs.

The main purpose of this article is to study what nurses consider most important when focusing on patient safety. The study uses a qualitative design based on focus group interviews with nurses who work with acute, critically ill patients in hospitals. Two hospitals were chosen. The data collection was conducted in October and November 2002. The research comprised 23 nurses with specialist degrees, including one man, divided into four groups. The criterion for inclusion in the study was being a nurse with advanced training in anesthesiology, intensive care, or operating-room nursing. The nurses were between 35 and 61 years old. The job experience as nursing specialist varied from ¾ to 32 years. The findings show that the informants were concerned with patients' safety, and they placed a considerable emphasis on their personal responsibility for safety. The informants discussed safety in relation to themselves and their colleagues, and to a lesser degree with respect to their level in the organizational structure. The nurses were concerned with themselves, their own attitudes, and efficient teamwork with other groups of professionals. Cooperation requires speaking the same language. Different cultural and linguistic backgrounds can be problematic. They had written procedures that were not based on higher national or international standards. Both standards and individual judgment were evaluated as important for patient safety.

Health promotion among older people may be considered as prevention of avoidable decline, fragility, and dependence. Risk factors that increase an individuals' level of fragility are chronic diseases, acute or subacute events, and inactivity. Benefits of physical activity among older people have been reported, and fitness training may be regarded as an important strategy for promoting health among the aged. The aim of this study was to investigate if physical activity, life situation, sense of coherence, and self-care may be associated with perceived health and well-being in a group of physically active older Swedish people. Data were collected by means of a questionnaire that was filled out by 146 conveniently chosen physically active older individuals in eastern Sweden. Statistical methods used were Student's t-test for independent samples, chi-square test, Fisher's exact test, Pearson's correlation test, and stepwise multiple regression analysis. The results showed that chronic disease/handicap and sense of coherence were significant determinants for perceived health in the study group. For well-being was sense of coherence the only significant determinant. Health promotion among older people should primarily focus on the individuals' resources to cope with life situation and events in daily life. Supportive actions related to disease, changes in life situation and daily life should also be important to emphasise in health promotion and health care for older people.

An accelerated stay program has been used for all women referred to Hvidovre Hospital for hysterectomy since the year 2000. This has reduced the length of hospital stay, but do they need further follow-up or health care counselling after discharge?

This randomised controlled trial includes 59 hysterectomised women. The intervention group (n=30) received a follow-up phone call four-six days after discharge. Both groups received a questionnaire two weeks after discharge including questions concerning unsolved problems and the women's need for further follow-up. Telephone interviews after two-four months revealed actual resumption of work and reasons for prolonged sick leave.

There was no difference between the number of women with questions that remained unanswered or the need for a nurse initiated telephone follow-up in the two groups. The women resumed work after median 28 days in the trial group and after median 26 days in the control group.

The planned telephone contact did not reduce the number of unsolved problems dramatically, probably because of the variation in time for occurrence of the problems. Considering the number of complications found in this and other studies, post discharge follow-up should be optional for all women after hysterectomy — also in an accelerated stay program.

All students starting nursing education in August 2001 at Vestfold University College were asked to take part of a longitudinal study. They were invited to fill in a questionnaire consisting of demographic data, data related to motivation, expectation to the nursing programme and study habit in the beginning of their study (phase one). When the second phase of the longitudinal study started at the end of the three year educational programme, 24 of 76 students were no longer on the class-list. Why?

The aim of this study was to explore how many nursing students dropped out or prolonged their study (stopout). When did they leave, how long did they stay out, who were they and for what reasons did they leave? What can the nursing university college do to prevent or reduce the leaving rate? An explorative, descriptive design with open-ended interviews was used. The interviews were mostly conducted by phone. The results showed that of 76 students, 8 dropped out, 13 used more than three years and 3 students finished their nursing education in three years in another university college. With the exception of academic failure and clinical experience there was no single contributing factor that made the students dropout or stopout, but factors such as pregnancy, sickness, personal crises and economy were identified.

The article debates how the aspect of content and action in nursing forms the basis of decisions about personal suitability as a requirement of qualification in nursing. The purpose is to procure useful knowledge for reflection about the jurisdiction of nursing in a market-oriented society, for help for nurse-managers in the recruiting- and selectionprocess. Through a descriptive embedded multiple case design with a qualitative approach, four recruiting- and selection contexts was studied. By means of a theoretical framework based on Human Resource Management theory and Herbert Simons propositions about bounded rationality, the data were analysed by Kvales ad hoc generation of meaning. Personal suitability is a requirement of qualification in nursing when aspects of content and action in nursing are well defined through a ward-specific job-analysis. The results of the analysis have to be used by the nurse-manager with right to nominate, as preferences in assessment of the applicants in the recruiting- and selectionprocess. Further, the formal authorisation criteria and the medical speciality at the ward, most not be the only preferences in assessment of the applicants. If so, the jurisdiction of professional skills in nursing will still remain subordinate the profession of medicine

The aim of this study was to develop an assessment tool for clinical nursing education specific for the three levels of undergraduate nursing education. The purposed context for the assessment tool was Swedish university baccalaureate nursing programs. The assessment tool was developed, tested and evaluated stepwise. First, a theoretical frame concerning knowledge and competence in nursing was developed assuming continuity between theoretical and practical knowledge out of complex competences. Then, objectives for learning in terms of competences were operationalized. The Sahlgrenska University Clinical Nursing Assessment Tool (SUCNAT) for the three levels of nursing education is structured into three areas of competences: practical skills, problem solving and reflection, and professional stance. It is aimed for student self evaluation in combination with nurse evaluation of student's competence as basis for evaluation of students in clinical education. In addition, a questionnaire to students, their supervisors and teachers, as well as discussions with expert panels enabled the development. Further research of the reliability, validity, and practical application of the assessment tool is suggested.

The Intensive Care Unit is an environment supplied with high technological equipment and specialized nurse staff who supervise the critical ill patient. The aim of this literature review was to illuminate how the equipment alarm can be of importance to the patient and to the Critical Care Registered Nurse's management. Findings from this study was that equipment alarm is an important environmental factor which can influence the critical ill patient negatively because it can develop the intensive care unit syndrome among patients treated in Intensive Care Units. Finding from this study was also that acoustic alarm from the equipment could be replaced with audiovisual alarm. Already Florence Nightingale pointed out the importance of silence and security to the ill patient and that it was of importance to avoid noise in the environment.

Construction of questionnaires is not as easy as it first may seem. There are several issues to consider. This to avoid problems later in the analysis of the results. This article aim at presenting a selection of possible methodology problems related to the construction and use of questionnaires.

To perform a scientific speech in fifteen minutes is sometimes more demanding than to have a longer lecture especially with regard to make the audience capture the most central messages. The use of rethoric tools can help the speeker to make a good performance and the audience to learn something from the lecture. This article aim at presenting a selection of rethoric tools to be used in the short scientific speech.

The role of the Nurse Practitioner has successfully been developed internationally within different areas of health care. To satisfy the needs of health care of the population in Sweden, an optimal utilization of the available resources is demanded and treatment of health care problems at an appropriate level of care is required to be able to give health care with good availability, high quality and safety. A collaboration started between the Primary Health Care in the county of Skaraborg and the University of Skövde to develop the role of the district nurses in primary health care toward a more specialized function with the competence to independently make decisions and solve health care problems. The plans of this new role in the health care system gained approval at the National Board of Health and Welfare and other public authorities. St Martin's College, Great Britain and University of Rhode Island, USA have also been partners of collaboration. The result of the work became a curriculum of a new education in Sweden — Advanced Nursing Practice in Primary Health Care.

Health care reform has been happening in most countries of the world during the past two decades. The health care reform is a process guided by the prevailing ideological commitments to (a) improving health of the population, for example improving the quality of life, (b) an equitable care, although equity has different meanings from different orientations, (c) cost-containment and cost-efficiency, (d) increase in accountability, (e) scientific base of health care especially in terms of transfer of knowledge into practice, (f) consumer choice, and (g) quality care. One of the major shortfalls of the reform movement has been its inability to address the issues of health outcomes more directly. This paper proposes a model with which health-care professionals including nurses can address quality of practice in relation to health outcomes. It is a complex feedback process system consisting of (a) goals of patient care, (b) process of care, (c) quality of care, and (d) patient outcomes. In the model, goals, processes, quality, and outcomes are conceptualized as interdependent components that can bring about both effectiveness and efficiency of patient care through component-specific processes as well as coordinated, feedback processes.

The aim of this article is to provide an overview of the development of expert nurse education at the Swedish Polytechnic (SYH) in Finland. The education is comparable to the international Nurse Practitioner education.

SYH has received project funding from the Ministry of Education in order to develop the expert nursing role in Ostrobothnia. A steering group was formed in order to discuss and develop the role of the expert nurse, as well as the contents of the education pro gramme. During 2004, national research and education curricula have been outlined within the project framework. Regional outlines concerning the demand and role of expert nurses have also been made. The regional outline comprised one questionnaire (n=42) aimed at head nurses and doctors as well as nine focus group interviews with specialised nurses (n=46). The results of the outlines reveal that there is a demand within nursing organisations for expert nurses within many areas, particularly within acute health issues as well as within the treatment and follow-up of chronic diseases. The active engagement and co-operation of the steering group, within the Thematic European Nursing Network, have made it possible to develop and initiate a specialised education for expert nurses.